Provider Demographics
NPI:1386481786
Name:SILJEG, ERIC MICHAEL (SUDP, LPN)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:SILJEG
Suffix:
Gender:M
Credentials:SUDP, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 111TH ST S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-1526
Mailing Address - Country:US
Mailing Address - Phone:425-414-5302
Mailing Address - Fax:
Practice Address - Street 1:20508 56TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7650
Practice Address - Country:US
Practice Address - Phone:425-678-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP61571606164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse